Exploring the link between sexualized behaviour and sexual abuse in a clinical setting

This study examined the issue of sexualized behaviour in children as an indicator of sexual abuse. The purpose was to develop alternative explanations for sexualized behaviour if sexual abuse was not confirmed or suspected. Other possible explanations explored were the presence of frequent disruptions to family life, previous unresolved exposure to sexual abuse or contact with a sexualized child. Data were collected on 81 cases of sexualized behaviour referred to a specialist child protection assessment unit over a 7‐year period. It was found that in very few cases was sexual abuse considered an explanation for the sexualized behaviour. Of the remaining cases, a substantial number showed evidence of family disruption, which could lead to sexualized behaviour developing as a comforting response for the child. Furthermore, a number of children also had experienced sexual abuse in the past, which might have been unresolved for the child, or had contact with another sexualized child, and this might have accounted for their behaviour. It would appear that many of the children were facing difficulties in their lives and might require therapeutic intervention, even if concerns about recent sexual abuse had been allayed. Copyright © 1999 John Wiley & Sons, Ltd.     

The impact of childhood stressful life events on health and behavior in at-risk youth

Stressful life events experienced in childhood affect heath throughout the lifespan. Given the high prevalence of stressful life events, especially for children at-risk for child welfare involvement, the impacts of these events across different developmental stages need to be better understood. The current study examines the relation between previously experienced stressful life events and psychosocial health and risk behaviors in adolescence. Several links between maltreatment and psychosocial health were found. Namely, youth who had experienced sexual abuse were more likely to report anxious arousal symptoms, youth who had experienced physical maltreatment and emotional maltreatment were more likely to drop out of school, and youth who had experienced neglect were more likely to dropout, have unprotected sex and use cigarettes. Latent class analysis of life events revealed three groups of children with certain patterns of life events: Chronic, Moderate/Declining, and Low Life Events. After accounting for gender, race, and exposure to maltreatment, members of the Chronic Life Events group uniquely and significantly predicted higher likelihood of Anger/Irritability, Depression, Intrusive Experiences, and Dissociation on the Trauma Symptom Inventory at age 18. Additionally, members of the Chronic Life Events group were significantly more likely to drop out of school, have more sexual partners, be arrested more often and use marijuana or other illicit drugs more often. Membership in the Moderate/Declining Life Events group was significantly associated with likelihood of dropping out of school. The amount of stressful life events appears to be strong predictors of psychosocial outcomes and risk behaviors in adolescence. Efforts to intervene and prevent childhood exposure to stressful life events—particularly in children at-risk and/or maltreated—should begin early in life and continue throughout childhood and adolescence.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.     

Self-reported and case file maltreatment: Relations to psychosocial outcomes for youth in foster care

The aim of the current study was to explore the relation between maltreatment and psychosocial outcomes for youth in foster care, and how this relation differs according to reporter type (self-report or case file). Participants included 285 children and adolescents and their caregivers who completed self-report questionnaires about lifetime maltreatment and psychosocial adjustment. Youths' case files containing lifetime maltreatment reports were obtained from Division of Social Services (DSS), and were coded for physical and sexual abuse, emotional maltreatment, and neglect using the Modified Maltreatment Classification System (MMCS; English & LONGSCAN Investigators, 1997). Crosstabs analysis was used to summarize proportions of youth whose caregivers reported clinically significant internalizing and externalizing and average to high adaptive functioning within groups of youth who had a) neither self-reported nor case file maltreatment, b) only case file maltreatment, c) only self-reported maltreatment, and d) both case file and self-reported maltreatment for each maltreatment type (physical and sexual abuse, emotional maltreatment, and neglect). Results showed that externalizing symptoms differ according to reporter type for physical and sexual abuse, and that internalizing symptoms differ according to reporter type for sexual abuse. Implications for methodology in maltreatment research are discussed.     

Prevalence of childhood abuse in mothers taking part in a study of parenting their own children

This paper describes the incidence of maltreatment histories in a community sample of mothers of one‐year‐old infants in Northern Ireland. The occurrence of five subsets of childhood maltreatment is examined: emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse. Of the 201 women who completed the Childhood Trauma Questionnaire, 70 mothers (35%) reported that they had experienced one or more types of maltreatment during childhood. Forty‐eight mothers (24%) gave a history of being emotionally abused, 43 (21%) of emotional neglect, 27 (13%) of physical abuse, 20 (10%) of sexual abuse and 19 (10%) of physical neglect. Physical abuse was the only type of maltreatment which showed an association with maternal socio‐economic status, with a higher incidence reported amongst Occupational Classes 4 and 5 (lower supervisory and technical occupations and semi‐routine and routine groups). More than half of those with a history of abuse experienced more than one type of maltreatment (42 mothers or 60% of those reporting maltreatment). Differences in rates of incidence to more recent studies on younger adults are discussed, as well as implications for prevention and intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Physical,sexual and psychological abuse in high school dating relationships: Prevalence rates and self-esteem issues

The present study examined the rates of victimization by physical, sexual and psychological abuse in adolescent dating relationships, with self-esteem being explored as a mediating variable. Subjects included 257 students from a coed, ethnically diverse, religiously affiliated high school. Information was obtained using a self-report questionnaire on teenage dating behaviors. Of the 114 male and 118 female subjects who had dating experience, 59% had been victimized at least once in some past or current dating relationship by physical violence, 96% had experienced some form of psychological maltreatment and 15% had been forced to engage in sexual activity. Significantly more males than females reported experiencing physical abuse overall. Significantly more males than females experienced acts of moderate physical abuse, while there was no significant gender difference in the experience of acts of severe physical abuse. Thirteen percent of the subjects stated they had remained in a physically abusive relationship at one time, with females being more likely to remain than males. Self-esteem was not a factor in the level of physical abuse sustained in dating relationships, nor was there a significant difference in the levels of self-esteem between subjects who remained in, terminated, or never were involved in, physically abusive dating relationships. For all subjects, self-esteem negatively correlated with the level of psychological maltreatment sustained in dating relationships, but separate analysis by gender found the correlation was significant only for female subjects.     

Why should child welfare pay more attention to emotional maltreatment?

A significant body of research indicates that emotional maltreatment (EMT) is harmful to children, resulting in long-term negative impacts on emotional and behavioral development. The child welfare system's focus on physical abuse, physical neglect, and sexual abuse has led a relative lack of attention to EMT. Reported rates of EMT vary widely across states – ranging from 0.2% to 44.9% in a recent national report on child maltreatment – indicating that it is not being measured consistently. This paper uses data collected by the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to (1) describe the nature and characteristics of emotional maltreatment experienced by 846 LONGSCAN youth across time, and (2) describe the relation between four subtypes of emotional maltreatment (psychological safety and security, acceptance and self-esteem, autonomy, and restriction) and child trauma symptoms and risk behaviors at age 18. Exposure to EMT was related to increased trauma symptoms and risky behaviors. EMT is common, identifiable, harmful, and potentially preventable; and a better understanding of it will help to inform the provision of effective child welfare and mental health services to children and their families. Findings suggest a need for greater understanding of parental behaviors, and the motivations behind them, that result in emotionally harmful outcomes for children, as well as a better understanding of appropriate interventions for children who experience various types of EMT.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Depression and Parenting by Nonoffending Mothers of Children Who Experienced Sexual Abuse

Parenting may be one mechanism by which depression in nonoffending mothers impacts child emotional and behavioral adjustment after sexual abuse. This study examined the relationship between self-reported maternal depression and parenting behaviors by nonoffending mothers of children who experienced sexual abuse. The participants were 204 nonoffending biological mother–child pairs recruited from a clinic providing services for children who experienced sexual abuse. The mothers completed pretreatment self-report measures of demographic information, depression, and parenting behaviors. Children (7 to 17 years) completed a measure of mothers’ parenting behaviors. Mothers with clinically high levels of self-reported depression employed more inconsistent parenting behavior and provided poorer monitoring/supervision of their children than mothers without clinically high levels of self-reported depression. Implications for clinical practice and future research are discussed.     

Exploring the Relationship Between Adverse Childhood Experiences and Hope

ABSTRACT

To explore the relationship between adverse childhood experiences and hope, a convenience sample of caregivers bringing in children for medical investigation of child abuse at a regional child advocacy center were surveyed for adverse childhood experiences and dispositional hope. Hope in this sample had a significant negative correlation to the adverse childhood experiences subscale “abuse” (r = –.19; p < .05). The relationship between hope and the other adverse childhood experiences subscales “neglect” (r = –.14) and “dysfunctional family” (r = –.16) was not statistically significant. An analysis of variance was performed to determine if caregivers who have experienced both sexual and physical abuse (M = 29.67; SD = 15.96) have lower hope scores compared to those caregivers who have experienced neither physical nor sexual abuse (M = 42.64; SD = 18.44). This analysis (F (1, 84) = 5.28; p < 0.05) showed that caregivers who experienced both physical and sexual abuse scored significantly lower on hope compared to their counterparts who experienced no adverse events, with an estimated effect size of moderate strength (d = 0.70). Higher adverse childhood experiences scores are associated with lower hope. This result was especially true for those adult caregivers who reported experiencing both physical and sexual abuse when compared to adults who did not experience either form of child trauma. While the empirical literature continues to demonstrate the negative consequences of adverse childhood experiences across the life span, hope offers a compelling new line of inquiry in child maltreatment research especially for studies targeting prevention or intervention.     

The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination

Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines 5 potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0–11) with cases processed during 1967–1971 were matched with nonabused, nonneglected children and followed into young adulthood. Data are from in-person interviews at approximately age 29 and arrest records through 1994. Structural equation modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.     

Propensity to perpetrate abusive behaviors: Internet survey of the role of gender,childhood maltreatment,and perception of maltreatment in Nigeria

This article reports on propensity to perpetrate abusive behaviors and examines the role of gender, childhood maltreatment, and perception of abusive behaviors on the propensity. Findings suggest that propensity to perpetrate abusive behaviors cuts across all types of maltreatment (i.e., physical, sexual, and emotional abuse, child neglect, and child labor). Although abusive behavior with high propensity for perpetration includes corporal punishment, propensity to perpetrate abusive behaviors differed by gender. Men were more likely than women to indicate propensity to perpetrate abusive behaviors. Those who perceived behaviors as not abusive, as well as those who reported childhood experience of abusive behaviors, were more likely to intend to perpetrate abusive behaviors. Although childhood experience of sexual abuse was related to perpetration of sexual abuse, history of perpetrating sexual abuse comprised the largest effect size of the propensities to perpetrate abusive behaviors. Implications of findings for policy, practice, and services are discussed.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Domestic Violence and Intergenerational Rates of Child Sexual Abuse: A Case Record Analysis

Using case review at a shelter for battered women and their children, this exploratory study investigated the association between physical abuse, exposure to domestic violence and intergenerational occurrence of child sexual abuse. The charts of 570 children were reviewed in an attempt to explore the relationship between the children's experiences with sexual abuse and their nonoffending parent's own history of having been sexually abused. Results indicated that a significant percentage of nonoffending parents who reported a history of child sexual abuse also had children who were sexually abused. Additionally, we found that most (93%) of the children studied had been exposed to domestic violence, and while the base rate of sexual abuse was relatively low (11%), the rate of physical abuse of the children was substantial (41%). Logistic regression results indicated that children of sexually abused nonoffending parents may be at heightened risk for sexual abuse. Implications for treatment and intervention are discussed.     

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children’s discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children’s HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler–canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.     

Intergenerational Patterns of Maltreatment in Families at Risk for Foster Care

Few qualitative studies have investigated the process of parental efforts to break intergenerational patterns of maltreatment. A grounded theory approach was used to understand how 24 parents who had been identified by CPS as being at‐risk of having their children removed from their homes due to allegations of abuse and/or neglect, perceived and connected their own experiences of childhood abuse in light of their experiences as alleged perpetrators of child maltreatment. Three major categories were identified: patterns, beliefs, and behaviors. A majority of the parents stated that they recognized intergenerational patterns, most expressed that they wanted to be different from their own parents, yet many described parenting actions that were “destructive.” We suggest that it is the interrelationship amongst patterns, beliefs, and behaviors that may offer opportunities for parents and therapists to enact change.     

Child Advocacy Center Based Group Treatment for Child Sexual Abuse

The present study examines initial symptom presentation among participants, outcomes, and social validity for a group treatment for child sexual abuse delivered at a child advocacy center. Participants were 97 children and their nonoffending caregivers who were referred to Project SAFE (Sexual Abuse Family Education), a standardized, 12-week cognitive-behavioral group treatment for families who have experienced child sexual abuse. Sixty-four percent of children presented with clinically significant symptoms on at least one measure with established clinical cutoffs. Caregivers of children who presented with clinically significant symptoms reported more distress about their competence as caregivers. Children who presented as subclinical were more likely to have experienced intrafamilial sexual abuse. Posttreatment results indicated significant improvements in functioning for all children who participated in treatment, with greater improvements reported for children who initially presented with clinically significant symptoms. Overall, the program was rated favorably on the posttreatment evaluation of social validity.     

A relational understanding of the needs of siblings of children who have been sexually abused

This participatory research project highlighted the views and experiences of young people who are the brothers and sisters of children and young people who have experienced child sexual abuse. By working with young people who had experienced sexual abuse and their siblings, this practitioner research sought to give these young people a voice. The research involved a group process with young people who have experienced sexual abuse and have siblings, and one-to-one online consultations with the brothers and sisters of young people who have experienced abuse. All the young people spoke of their sibling and family relationships as unique and requiring unique responses to these relationships by services and health-care professionals. Siblings’ needs in the aftermath of a child sexual abuse discovery are often overlooked. This research describes how just as children who have experienced sexual abuse may feel anger, fear, guilt, shame, anxiety, and confusion, so do their siblings. Brothers and sisters of young people who have experienced sexual abuse describe significant relational trauma with intense emotional experiences of isolation, confusion, sadness, and anger. There is a real need to support young people and families to find words and develop capacities to talk about child sexual abuse -- a need to find supportive ways to speak about what has occurred and understand its impact on all. The study clearly demonstrated the significant level of need and impact on brothers and sisters of young people who have experienced sexual abuse.     

Therapeutically Managing Reunification After Abuse Allegations

School-based programs have been the central strategy to educate children about the serious nature of child sexual abuse in the hope of prevention or early intervention. Virtually all evaluations have been quantitative, seldom allowing children to directly comment on their experiences. This article presents the results of qualitative research with 116 students (51 boys and 65 girls) ranging from age 6 to 12 who had participated in the Who Do You Tell child sexual abuse education program. Ten focus groups were conducted with students in separate grades, from kindergarten through sixth grade, two to three months after program participation. The core themes that emerged from the focus group interviews are presented, as are implications for child sexual abuse prevention programs.